Provider Demographics
NPI:1376724575
Name:AMERICAN SKIN AND CANCER CENTER PC
Entity Type:Organization
Organization Name:AMERICAN SKIN AND CANCER CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAR
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-446-1070
Mailing Address - Street 1:25 1ST AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1284
Mailing Address - Country:US
Mailing Address - Phone:559-446-1070
Mailing Address - Fax:877-300-7092
Practice Address - Street 1:25 1ST AVE STE 113
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-1285
Practice Address - Country:US
Practice Address - Phone:559-446-1070
Practice Address - Fax:877-300-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07004000207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07004000OtherMEDICAL LICENCE NUMBER
NJ25MA07004000OtherMEDICAL LICENCE NUMBER
NJ041103Medicare PIN